A quantitative analysis of the relationship between posttraumatic growth, depression and coping styles after burn

Perceived stress and posttraumatic growth in caregivers of pediatric burn patients undergoing mHealth-enhanced outpatient burn care: A pilot study

Approximately 120,000 children in the United States are evaluated in the emergency department annually due to burn injuries. Studies have consistently documented that pediatric burns are among the most stressful events for caregivers, resulting in a wide range of emotions, including guilt, anxiety, grief, depression, and posttraumatic stress symptoms, as well as positive psychological changes, a phenomenon known as posttraumatic growth. The present pilot study aimed to explore the prevalence of elevated perceived stress as well as posttraumatic growth among caregivers of pediatric burn patients receiving outpatient burn care and using an mHealth burn platform to administer burn treatment. Our results demonstrated that, on average, caregivers endorsed similar or lower levels of perceived stress over the past 30 days compared to the general population of 30-44-year-old adults and only a third of caregivers reported elevated levels of perceived stress in the past 30 days. However, during the treatment phase, two-thirds of caregivers reported elevated levels of stress. Further, approximately half of the caregiver sample reported moderate to high levels of posttraumatic growth following their child's burn injury. This pilot study clarifies the level of the perceived stress that caregivers of burn-injured children experience, particularly during the treatment phase when they are responsible for their children's outpatient burn care (e.g., dressing changes). Additionally, the results shed light on the high prevalence of moderate to high posttraumatic growth in caregivers, with a prevalence rate similar to other trauma survivors.

The long-term intercorrelation between post-burn pain, anxiety, and depression: a post hoc analysis of the "RE-ENERGIZE" double-blind, randomized, multicenter placebo-controlled trial

BACKGROUND

Despite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise.

METHODS

RE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment. For the post hoc analysis, we excluded participants who did not complete the Short Form Health Survey (SF-36) questionnaire. Normative data were taken from the 2021 National Health Interview Survey dataset. Propensity score matching was performed using the nearest-neighbor 1-to-1 method, and the two cohorts were compared in terms of chronic pain, and symptoms of anxiety and depression. A multivariable analysis was performed on the burns cohort to identify factors predicting post-discharge pain and symptoms of anxiety and depression.

RESULTS

A total of 600 burn patients and 26,666 general population adults were included in this study. Following propensity score matching, both groups comprised 478 participants each, who were predominately male, white, overweight and between 20 and 60 years old. Compared to the general population, burn patients were significantly more likely to report the presence of moderate and a lot of pain (p = 0.002). Symptoms of anxiety were significantly higher in the burn population in two of four levels (most of the time; some of the time; p < 0.0001 for both). Responders in the burn population were significantly less likely to report the absence of depressive symptoms (p < 0.0001). Burn patients were also significantly more likely to report that their mental health affects their social life. TBSA, history of depression, and female sex were identified as independently associated factors for pain, anxiety, and depressive symptoms. The presence of chronic pain and anxiety symptoms independently predicted for symptoms of depression.

CONCLUSIONS

Analyzing the largest multicenter cohort of patients with extensive burns, we find that burn injury is associated with chronic pain, and symptoms of anxiety and depression. In addition, TBSA-burned and history of depression directly correlate with the prevalence of chronic pain, and symptoms of anxiety and depression. Finally, pain, and symptoms of anxiety and depression are interrelated and may have interactive effects on the process of recovery following burn injury. Burn patients would, therefore, benefit from a multidisciplinary team approach with early mobilization of pain and mental health experts, in order to promptly prevent the development of psychosocial challenges and their consequences.

The gut microbiota regulates the depressive-type behaviors and inflammatory processes after severe burn injuries in mice

An emerging number of studies have recently revealed the correlation between burn injuries and psychological disorders. Gut microbiota and inflammatory factors may play a vital role in this process. Nevertheless, there are few studies conducted to disclose the potential mechanism of the gut microbiota between depression and burn injuries. In this study, we constructed a burn model of C57BL/6 mice, which showed that the symptom of depression became more and more severe with the burn of mice lasted longer. Meanwhile, there are significant differences of composition of gut microbiota among mice before and after burn. Then, we tested the inflammatory factors in the brain and peripheral blood, which showed an increased expression of Iba1, VWF, TNF-α and IL-6, and a decreased expression of IL-10 in burn mice. In addition, the expression of zonula occludens-1 (ZO-1) in cecum showed a down-regulation in burn mice, which indicated impaired intestinal barrier function. Lastly, the crossing fecal microbiota transplantation (FMT) and cohousing experiment were conducted to determine the functions of cross-transplantation of fecal microbiota on the depressive-type behaviours in burned mice. According to the score of Tail suspension test (TST), the burn mice were divided into two groups: Resilient mice (no-depressed mice) and Abnormal mice (depressed mice). After abnormal mice were transplanted with fecal microbiota of resilient mice, the symptom of depression was improved, and the expression of TNF-α, IL-6 and IL-10 return to normal levels (P < 0.05). On the contrary, after resilient mice were transplanted with fecal microbiota of abnormal mice both the TST scores and inflammatory factor developed depressive-type changes. In conclusion, our study demonstrated the changes of gut microbiota and inflammatory factors in depressed burn mice and non-depressed burn mice. The gut microbiota dysbiosis could impaired intestinal barrier function and lead to neuroinflammation, and this phenomenon could be significantly mitigated by FMT.

Association between self-disclosure and benefit finding of Chinese cancer patients caregivers: the mediation effect of coping styles

PURPOSE

To examine the relationship between self-disclosure, coping styles, and benefit finding (BF) among caregivers of cancer patients. The study also aimed to identify the factors influencing BF and the impact of coping styles on the relationship between self-disclosure and BF.

METHODS

Convenience sampling was used to select 300 caregivers of cancer patients aged greater than 18 years from October 2022 to April 2023 in Chengdu, China. The demographic and clinical characteristics questionnaire, the Benefit Finding Scale (BFS), the Distress Disclosure Index Scale (DDI), and the Simple Coping Style Scale (SCSQ) for caregivers were included in this study. Descriptive statistics, t-tests, one-way analysis of variance, Pearson's correlation analyses, and multiple linear regression models were used. The effect of mediation was tested by the PROCESS macro (Model 4) for SPSS 26.0 by Hayes using 5000 bootstrap samples.

RESULTS

There were 292 valid questionnaires (effective response rate 97.33%). The total scores of BF, self-disclosure, negative coping style, and positive coping style of caregivers were 67.77 ± 14.78, 38.23 ± 8.59, 19.68 ± 5.98, and 9.88 ± 4.18, respectively; Pearson's correlation analysis showed that BF was positively correlated with self-disclosure, positive coping, and negatively correlated with negative coping; multiple linear regression analysis showed that self-disclosure, positive coping, and negative coping were influential factors of BF. The results revealed that the effect of self-disclosure on BF was partly mediated by coping styles. It also confirmed that the mediation effect accounted for 54.03% of the total effect.

CONCLUSION

The BF of caregivers is at a moderate level. Self-disclosure may influence BF partly because of coping styles.

Exploring the coping strategies of women after self-immolation: A qualitative study

BACKGROUND

Women confront a slew of issues following self-immolation, and it is crucial to examine how women react after self-immolation and live with their scars. Therefore, this study was conducted with the aim of exploring the coping strategies of Kurdish women following self-immolation using a qualitative methodology.

METHODS

The conventional content analysis approach was used in this qualitative investigation. Semi-structured face-to-face and phone interviews were conducted with 26 Kurdish women who had self-immolated and were chosen using purposeful sampling and snowballing for this study. To reinforce the research, Guba and Lincoln's trustworthiness criteria were fulfilled.

RESULTS

The data analysis yielded 2 categories, 11 subcategories, and 85 initial codes. Positive coping is one of the categories and subcategories (spirituality, rebuilding their body, psychological rehabilitation, hiding the scars, restoring self-confidence, changing the lifestyle, forming a new life) 2- Negative coping (separation from society, neglecting the body and mind, violence and aggression, staying in the past).

CONCLUSION

Using the capacity of religious organizations to help victims of self-immolation, providing appropriate conditions and facilities to heal the scars caused by self-immolation, and facilitating access to counseling services can provide the conditions for women to better adapt after self-immolation.

Significance of Post-Traumatic Growth and Mental Health for Coping in Multiple Sclerosis Caregivers

We investigated the influence of post-traumatic growth (PTG) and mental health (MH) on multiple sclerosis (MS) caregivers' uses of coping strategies and identified biopsychosocial predictors of proactive or reactive coping. The Short Form Health Survey (SF-12), General Health Questionnaire (GHQ-28), Post-Traumatic Growth Inventory (PGI-21), Brief COPE Questionnaire (COPE-28), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate 209 caregivers. Higher PTG was related to greater use of emotional support, positive reframing, religion, active coping, instrumental support, planning, denial, self-distraction, self-blaming, and venting. Better MH was associated with greater use of acceptance, while behavioral disengagement and self-distraction were associated with poorer MH. The PTG dimensions relating to others and new possibilities, SF-12 dimensions of physical and emotional roles as well as partnership, not living with the patient, and significant others' social support were predictors of proactive coping. Reactive coping was positively predicted by the PTG dimension relating to others, depression, vitality, other than partner relation, and physical role, and negatively predicted by mental health level and emotional role. In summary, higher MH was associated with proactive coping strategies, whereas post-traumatic growth was related to the use of a wide range of proactive coping as well as reactive coping strategies.

Impacts of Financial Assistance on Quality of Life Among People Living With Burn Injury: Matched Cohort Analysis of the National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System Database

Disparities in socioeconomic status and minority status affect the risk of burn injury and the severity of that injury, thus affecting the subsequent cost of care. We aimed to characterize the demographic details surrounding receipt of financial assistance due to burn injury and its relationship with health-related quality of life scores. Participants ≥18 from Burn Model System National Longitudinal Database (BMS) with complete demographic data were included (n = 4330). Nonresponders to financial assistance questions were analyzed separately. The remaining sample (n = 1255) was divided into participants who received financial assistance because of burn injury, those who received no financial assistance, and those who received financial assistance before injury and as a result of injury. A demographic and injury-characteristic comparison was conducted. Health-related quality of life metrics (Satisfaction with Life, Short Form-12/Veterans RAND 12-Item Health Survey, Community Integration Questionnaire Social Component, and the Post-Traumatic Growth Inventory) were analyzed preinjury, then 6-months, 1-year, and 2-years postinjury. A matched cohort analysis compared these scores. When compared to their no financial assistance counterparts, participants receiving financial assistance due to burns were more likely to be minorities (19% vs 14%), have more severe injuries (%TBSA burn 21% vs 10%), and receive workers' compensation (24% vs 9%). They also had lower health-related quality of life scores on all metrics except the post-traumatic growth inventory. Financial assistance may aid in combating disparities in posttraumatic growth scores for participants at the greatest risk of financial toxicity but does not improve other health-related quality of life metrics.

Motivating patients towards better recovery after burn: The development of a booklet to reframe perspectives

INTRODUCTION

Posttraumatic growth after burn results from integrated changes in worldview. It incorporates acceptance, belief in the self, compassion, determination and planning, emotional management and family/friend support.

METHOD

The booklet was developed in two phases. In the first phase burn survivors were invited to tell their stories pertaining to their burn recovery experiences. These stories were categorised into the above framework, and presented alongside supporting information from the burn clinical psychologist in an initial draft of the booklet. In the second phase of the study, a combination of one-to-one interviews and a focus group of burn survivors discussed, suggested improvements to the final booklet and evaluated for usefulness and acceptability.

RESULTS

A booklet was developed with a blend of patient stories and professional advice to positively reframe, integrate changed perspectives and motivate patients towards better psychological recovery after burn. It was evaluated to be useful and acceptable to new burn patients.

CONCLUSION

This booklet, designed to positively reframe perspectives for better psychosocial burn recovery, was developed with patients and evaluated by patients. It was found to be useful and acceptable to new burn patients.